Provider Demographics
NPI:1710252572
Name:SCARBOROUGH, JONATHON STANLEY (CRNA)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:STANLEY
Last Name:SCARBOROUGH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ELM COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-4805
Mailing Address - Country:US
Mailing Address - Phone:830-688-3172
Mailing Address - Fax:
Practice Address - Street 1:1509 DR. HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426
Practice Address - Country:US
Practice Address - Phone:940-683-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX733352367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered